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The articles we select for Evidence-Based Mental Health must pass two stages: first they must pass our basic validity criteria and then the editors assess each article for clinical relevance. A number of articles meet the inclusion criteria but are not abstracted due to lack of space. We will highlight the most interesting of these here and list the rest.
Antidepressants have been under a cloud of late. Reports of hidden trial data, toxic effects, and claims that they are mostly ineffective add to a belief that they are grossly over-prescribed, at least in those with less severe depression. “Psychotherapies for all!” is the new demand. Perhaps inappropriate, certainly unrealistic, but what’s the alternative? “Better to hunt in fields, for health unbought, than fee the doctor for a nauseous draught. The wise for cure on exercise depend”. So wrote Dryden in 1700 and more evidence for the benefits of exercise is provided by this RCT (Psychosom Med 2007;69:587–96) showing that for people with mild to moderate depression aerobic exercise training was as effective as sertraline. An unusual sample of recruits though, volunteering for exercise therapy. How many depressed patients in your clinic would be persuaded to try it?
In the UK a new Mental Capacity Act governs treatment without consent where patients lack capacity (or competence) to make decisions unless, confusingly, you have a mental illness in which case compulsory treatment will be governed by a new Mental Health Act. Despite much evidence to the contrary, for many healthcare professionals a history of mental illness and capacity (or competence) to consent to treatment are mutually exclusive. This myth is challenged once again by a systematic review (Br J Psychiatry 2007;191:291–7) showing that although incapacity, with a prevalence of 30%, is common in psychiatric inpatients, it is …
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